SIJ Bundles Fluoro in 2012
By Justin Vaughn, M.Div, CPC
Director of Compliance

10/17/2011

Beginning in 2012, pain physicians will no longer be able to bill for fluoroscopy when submitting claims for sacroiliac joint (SIJ) injections. According to the 2012 edition of the CPT coding manual, fluoroscopy (or other imaging guidance) will now be deemed an inherent part of the SIJ procedure, and thus no longer separately payable.
This latest move to roll back reimbursement for fluoroscopy comes on the heels of similar bundling of the radiological service in the recent past.  You may recall that the AMA bundled fluoroscopy with facet joint injections in 2010, and did the same with transforaminal injections in 2011.

This new rule for 2012 will be applicable across the payor spectrum; and, while you will not get reimbursed for the fluoro, you are nevertheless expected to utilize it (or other imaging guidance) during the SIJ procedure.  If you don’t, or fail to document it, the SIJ will be reimbursed as a trigger point.  Finally, you cannot circumvent the new rule by attempting to bill arthrography with your SIJ injections, as the arthrography code, 73542, has also been deleted from the 2012 CPT coding manual.

The trend is certainly troublesome.  Chronic pain providers have taken some direct hits in reimbursement in recent years, and will need to be prepared to absorb this latest salvo against them. 

The information presented herein reflects general information that is current as of the date it was first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.